CORONAVIRUS (COVID-19)

Resources on COVID-19 and how BCBSND is responding to help protect all North Dakotans

Knee Orthosis

Section: Orthotic & Prosthetic Devices
Effective Date: October 01, 2019
Revised Date: October 18, 2019
Last Reviewed: July 16, 2019

Description

An orthosis (brace) is a rigid or semi-rigid device which is used for the purpose of supporting a weak or deformed body member or restricting or eliminating motion in a diseased or injured part of the body. It must provide support and counterforce (i.e., a force in a defined direction of a magnitude at least as great as a rigid or semi-rigid support) on the limb or body part that it is being used to brace. An orthosis can be either prefabricated or custom-fabricated.

Criteria

Prefabricated Knee Orthosis

A knee orthosis, elastic with joints, or knee orthosis with condylar pads and joints, with or without patellar control may be considered medically necessary for ambulatoryindividuals who have weakness or deformity of the knee and require stabilization.

If the knee orthosis, elastic with joints, or knee orthosis elastic with condylar pads and joints, with or without patellar control, is provided but the criteria above are not met, the orthosis is considered not medically necessary.

Procedure Codes

L1810 L1812 L1820

A knee orthosis, with a locking knee joint, or a rigid knee orthosis may be considered medically necessary forindividuals with flexion or extension contractures of the kneewith movement on passive range of motion testing of at least 10 degrees (i.e., a non-fixed contracture).

If the knee orthosis, with locking knee joint, or rigid knee orthosis is provided but the criteria above is not met, the orthosis is considered not medically necessary.

Procedure Codes

L1831 L1836

A knee orthosis, double upright with adjustable joint, with inflatable air support chambers(s), also known as bladders, customized or off the shelf is considered not medically necessary. There is no proven clinical benefit to the bladder incorporated into the design.

Procedure Codes

L1847 L1848

A knee immobilizer without joints, a knee orthosis with adjustable knee joints, or a knee orthosis with adjustable flexion and extension joints that provides both medial, lateral and rotation control may be considered medically necessary if theindividual has a recent injuryor surgical procedure on the knee(s) and has ANY ONE of the following diagnosis:

  • Rheumatoid arthritis; or
  • Osteoarthritis; or
  • Meniscal cartilage derangement; or
  • Chondromalacia of patella; or
  • Knee ligamentous disruption; or
  • Rupture of tendon, non-traumatic - quadriceps tendon; or
  • Pathologic fracture of femur; or 
  • Pathologic fracture of tibia or fibula; or
  • Aseptic necrosis of tibia or fibula; or
  • Stress fracture of tibia or fibula; or
  • Congenital deformity of knee; or
  • Fracture of femur- lower end; or
  • Fracture of patella; or
  • Fracture of tibia and/or fibula - upper end; or
  • Dislocation of knee; or
  • Sprains and strains of knee; or
  • Failed total knee arthroplasty; or
  • Infection or other complications due to internal joint prosthesis; or
  • Knee joint replacement.

Knee orthosis with adjustable knee joints or a knee orthosis with adjustable flexion and extension joints may be considered medically necessary for an individualwho is ambulatory and has knee instability due to a condition specified in ANY ONE of the diagnoses listed above or ANY ONEof the following diagnoses:

  • Multiple sclerosis; or
  • Hemiplegia, unspecified; or
  • Infantile cerebral palsy, unspecified; or
  • Paraplegia of both lower limbs; or
  • Mononeuritis of lower limb, unspecified.

Knee immobilizer without joints, knee orthosis with adjustable knee joints, or a knee orthosis with adjustable flexion and extension joints that provides both medial, lateral and rotation control for any other condition not stated above is considered not medically necessary.

Procedure Codes

A9285 L1830 L1832 L1833 L1843 L1845 L1851
L1852

A knee orthosis, Swedish type, prefabricated may be considered medically necessary for an individualwho is ambulatory and has knee instability due to genu recurvatum - hyperextended knee.

A knee orthosis, Swedish type, prefabricated for any other condition is considered not medically necessary.

Procedure Codes

L1850

Knee orthosis with adjustable knee joint(s), knee orthosis with adjustable flexion and extension joints and knee orthosis, Swedish type require the knee instability be documented by examination and objective description of joint laxity (e.g., Varus/valgus instability, anterior/posterior Drawer test).

Knee orthosis with adjustable knee joint(s), knee orthosis with adjustable flexion and extension joints, and knee orthosis, Swedish typeare considered not medically necessary when the individual does not meet the above criteria.

Procedure Codes

A9285 L1832 L1833 L1843 L1845 L1850 L1851
L1852

Addition codes are considered not medically necessary if the base orthosis is considered not medically necessary or the addition is considered not medically necessary.

The following table lists addition codes which describe components or features that can be physically incorporated in the specified prefabricated base orthosis but are considered not medically necessary.

These addition codes, if they are billed with the related base code, are considered not medically necessary.

Base Code  Prefabricated Addition Codes - Not Medically Necessary
L1810 L2397
L1812 L2397
L1820 L2397
L1830 L2397
L1831 L2397, L2795
L1832 L2405, L2415, L2492, L2785
L1833 L2405, L2415, L2492, L2785
L1836 L2397
L1843 L2405, L2492, L2785
L1845 L2405, L2415, L2492, L2785
L1847 L2397, L2795
L1848 L2397, L2795
L1850 L2275
L1851 L2405, L2492, L2785
L1852 L2405, L2415, L2492, L2785

Custom Fabricated Knee Orthoses

General Criteria for Custom Fabricated Knee Orthoses:

  • A custom fabricated orthosis may be considered medically necessary when there is a documented physical characteristic which requires the use of a custom fabricated orthosis instead of a prefabricated orthosis. Examples of situations which meet the criterion for a custom fabricated orthosis include, but are not limited to: 
    • Deformity of the leg or knee; or
    • Size of thigh and calf; or
    • Minimal muscle mass upon which to suspend an orthosis.
  • Although these are examples of potential situations where a custom fabricated orthosis may be appropriate, suppliers must consider prefabricated alternatives such as pediatric knee orthoses inindividuals with small limbs, straps with additional length for large limbs, etc.
  • If a custom fabricated orthosis is provided but the medical record does not document why that item is medically necessary instead of a prefabricated orthosis, the custom fabricated orthosis is considered not medically necessary.
  • Custom fabricated orthoses are considered not medically necessary in the treatment of knee contractures in cases where theindividual is not ambulatory.

A custom fabricated knee immobilizer without joints may be considered medically necessary when BOTH of the following criteria are met:

  • The coverage criteria for the prefabricated orthosis, knee immobilizer without joints as mentioned above are met; and
  • The general criteria for a custom fabricated orthosis is met.

Custom fabricated knee orthosis may be considered medically necessary in non-ambulatory individuals with severe spastic conditions such as, but not limited to cerebral palsy.

Custom fabricated knee orthosis in non-ambulatory individuals for indications other than severe spastic conditions is considered not medically necessary.

If a custom fabricated knee immobilizer without joints is provided and both criteria above are not met, the orthosis is considered not medically necessary.

A custom fabricated derotation knee orthosis may be considered medically necessary for instability due to internal ligamentous disruption of the knee.

A custom fabricated knee orthosis with an adjustable flexion and extension joint may be considered medically necessary if ALL the following are met:

  • The coverage criteria for the prefabricated orthosis, and knee orthosis with an adjustable flexion and extension joint are met; and 
  • The general criteria for a custom fabricated orthosis are met.

If a custom fabricated knee orthosis with an adjustable flexion and extension joint is provided and both criteria above are not met, the orthosis is considered not medically necessary.

A custom fabricated knee orthosis with a modified supracondylar prosthetic socket may be considered medically necessary for an individualwho is ambulatory and has knee instability due to genu recurvatum - hyperextended knee.

A custom fabricated orthosis for any other condition not stated above is considered not medically necessary.

Procedure Codes

L1834 L1840 L1844 L1846 L1860

Addition codes are considered not medically necessary if the base orthosis is not medically necessary or the addition is not medically necessary.

The following table lists addition codes which describe components or features that can be physically incorporated in the specified custom fabricated base orthosis but are considered not medically necessary.

These addition codes, if they are billed with the related base code, are considered not medically necessary.

Base Code Custom Fabricated Addition Codes - Not Medically Necessary
L1834 L2397, L2800
L1840 L2275,L2800
L1844 None
L1846 None
L1860 L2397

Miscellaneous

Heavy duty knee joints, addition to lower extremity, straight knee joint and offset knee joint may be considered medically necessary forindividuals who weigh more than 300 pounds. They may also be considered medically necessary for individuals whose activity level requires extra support. This would extend but not be limited to professional athletes. Physician documentation would be required.

Coverage of a removable soft interface is limited to a maximum of two (2) per year beginning one (1) year after the date of service for initial issuance of the orthosis. Additional replacement interfaces are considered not medically necessary.

Heavy duty knee joints, addition to lower extremity, straight knee joint and offset knee joint for any other condition not stated above are considered not medically necessary.

Procedure Codes

K0672 L2385 L2395

Concentric Adjustable Torsion Style Mechanisms

Concentric adjustable torsion style mechanisms used to assist knee joint extension may be considered medically necessary:

  • For individuals who require knee extension assist in the absence of any co-existing joint contracture.

Concentric adjustable torsion style mechanisms for any other condition not stated above is considered not medically necessary.

Claims for devices incorporating concentric adjustable torsion style mechanisms used for the treatment of any joint contracture are considered non-covered.

Procedure Codes

E1810 L2999

Reasons for Non-coverage

Items that do not meet the definition of a brace are considerednon-covered.

Elastic support garments (e.g. made of material such as neoprene or spandex [elastane, Lycra®]) do not meet the definition of a brace because they are not rigid or semi-rigid devices and therefore, are considered non-covered.

Procedure Codes

A4467

Correct coding of prefabricated knee orthoses is dependent upon whether or not there is a need for minimal self-adjustment at the time of fitting by the individual, caretaker for the individual, or supplier that does not require the services of a qualified practitioner.

Procedure Codes

L1810 L1812 L1820 L1830 L1831 L1832 L1833
L1836 L1843 L1845 L1847 L1848 L1850 L1851
L1852

Quantity Level Limits (QLL) for custom fabricated knee orthosis

One (1) knee orthosis, i.e., one (1) RT modifier and/or one (1)LT modifier, per every three (3) years may be considered medically necessary as the reasonable useful lifetime of custom fabricated knee orthosis.

QLL or quantity of supplies that exceed the frequency guidelines listed on the policy are considered not medically necessary.

Procedure Codes

L1834 L1840 L1844 L1846 L1860

Quantity Level Limits (QLL) for prefabricated knee orthosis

One (1) knee orthosis, i.e., one (1) RT modifier and/or one (1)LT modifier, per every one (1) year may be considered medically necessary as the reasonable useful lifetime of prefabricated knee orthosis.

QLL or quantity of supplies that exceed the frequency guidelines listed on the policy are considered not medically necessary.

Procedure Codes

L1810 L1812 L1820 L1830

Quantity Level Limits (QLL) for prefabricated knee orthosis

One (1) knee orthosis, i.e., one (1) RT modifier and/or one (1)LT modifier, per every two (2) years may be considered medically necessary as the reasonable useful lifetime of prefabricated knee orthosis.

QLL or quantity of supplies that exceed the frequency guidelines listed on the policy are considered not medically necessary.

Procedure Codes

L1831 L1832 L1833 L1850

Quantity Level Limits (QLL) for prefabricated knee orthosis

One (1) knee orthosis, i.e., one (1) RT modifier and/or one (1)LT modifier, perevery three (3) years may be considered medically necessary as the reasonable useful lifetime of prefabricated knee orthosis.

QLL or quantity of supplies that exceed the frequency guidelines listed on the policy are considered not medically necessary.

Procedure Codes

L1836 L1843 L1845 L1851 L1852

Brace sleeves used in conjunction with orthoses are non-covered because they are not used to support a weak or deformed body member or to restrict or eliminate motion in a diseased or injured part of the body (i.e., it does not meet the definition of a brace).

Procedure Codes

A9270

Replacement

Replacement during the reasonable useful lifetime may be considered medically necessary if the item is lost or irreparably damaged. Replacement may be considered medically necessary when the individual has a progressive disease which renders the initial brace to be non-supportive before the reasonable useful lifetime of the brace. Documentation by a qualified physician is required. Replacement for other reasons, including but not limited to irreparable wear, during the period of reasonable useful lifetime is denied as non-covered. L-coded additions to knee orthoses will be denied as non-covered when the base orthosis is non-covered. Repairs to a covered orthosis are covered when they are necessary to make the orthosis functional. The reason for the repair must be documented in the supplier’s record. If the expense for repairs exceeds the estimated expense of providing another entire orthosis, no payment will be made for the amount in excess.

Replacement items not meeting the criteria above are considered not medically necessary.

Diagnosis Codes

Covered Diagnosis Codes for Procedure Codes L1831 and L1836

M24.561 M24.562

Covered Diagnosis Codes for Procedure Codes L1830 and L1834

G80.0 G80.1 G80.2 G80.3 G80.4 G80.8 G80.9
M05.061 M05.062 M05.261 M05.262 M05.361 M05.362 M05.461
M05.462 M05.561 M05.562 M05.661 M05.662 M05.761 M05.762
M05.861 M05.862 M06.061 M06.062 M06.1 M06.261 M06.262
M06.361 M06.362 M06.861 M06.862 M08.061 M08.062 M08.261
M08.262 M08.3 M08.461 M08.462 M08.861 M08.862 M08.961
M08.962 M12.061 M12.062 M17.0 M17.11 M17.12 M17.2
M17.31 M17.32 M17.4 M17.5 M17.9 M22.2X1 M22.2X2
M22.3X1 M22.3X2 M22.41 M22.42 M22.8X1 M22.8X2 M22.91
M22.92 M23.000 M23.001 M23.003 M23.004 M23.006 M23.007
M23.011 M23.012 M23.021 M23.022 M23.031 M23.032 M23.041
M23.042 M23.051 M23.052 M23.061 M23.062 M23.200 M23.201
M23.203 M23.204 M23.206 M23.207 M23.211 M23.212 M23.221
M23.222 M23.231 M23.232 M23.241 M23.242 M23.251 M23.252
M23.261 M23.262 M23.300 M23.301 M23.303 M23.304 M23.306
M23.307 M23.311 M23.312 M23.321 M23.322 M23.331 M23.332
M23.341 M23.342 M23.351 M23.352 M23.361 M23.362 M23.51
M23.52 M23.601 M23.602 M23.611 M23.612 M23.621 M23.622
M23.631 M23.632 M23.641 M23.642 M23.671 M23.672 M23.8X1
M23.8X2 M23.91 M23.92 M66.251 M66.252 M66.261 M66.262
M80.051A M80.051K M80.051P M80.052A M80.052K M80.052P M80.061A
M80.061K M80.061P M80.061S M80.062A M80.062K M80.062P M80.851A
M80.851K M80.851P M80.851S M80.852A M80.852K M80.852P M80.852S
M80.861A M80.861K M80.861P M80.861S M80.862A M80.862K M80.862P
M80.862S M84.351P M84.351S M84.352P M84.352S M84.361A M84.361K
M84.361P M84.361S M84.362A M84.362K M84.362P M84.362S M84.363A
M84.363K M84.363P M84.363S M84.364A M84.364K M84.364P M84.364S
M84.451A M84.451K M84.451P M84.451S M84.452A M84.452K M84.452P
M84.452S M84.461A M84.461K M84.461P M84.461S M84.462A M84.462K
M84.462P M84.462S M84.463A M84.463K M84.463P M84.463S M84.464A
M84.464K M84.464P M84.464S M84.551A M84.551K M84.551P M84.551S
M84.552A M84.552K M84.552P M84.552S M84.561A M84.561K M84.561P
M84.561S M84.562A M84.562K M84.562P M84.562S M84.563A M84.563K
M84.563P M84.563S M84.564A M84.564K M84.564P M84.564S M84.651A
M84.651K M84.651P M84.651S M84.652A M84.652K M84.652P M84.652S
M84.661A M84.661K M84.661P M84.661S M84.662A M84.662K M84.662P
M84.662S M84.663A M84.663K M84.663P M84.663S M84.664A M84.664K
M84.664P M84.664S M87.061 M87.062 M87.064 M87.065 M87.161
M87.162 M87.164 M87.165 M87.261 M87.262 M87.264 M87.265
M87.361 M87.362 M87.364 M87.365 M87.861 M87.862 M87.864
M87.865 M90.561 M90.562 M96.661 M96.662 M96.671 M96.672
Q68.2 Q68.6 Q74.1 S72.001K S72.001M S72.001N S72.001P
S72.001Q S72.001R S72.002K S72.002M S72.002N S72.002P S72.002Q
S72.002R S72.011K S72.011M S72.011N S72.011P S72.011Q S72.011R
S72.012K S72.012M S72.012N S72.012P S72.012Q S72.012R S72.021K
S72.021M S72.021N S72.021P S72.021Q S72.021R S72.022K S72.022M
S72.022N S72.022P S72.022Q S72.022R S72.024K S72.024M S72.024N
S72.024P S72.024Q S72.024R S72.025K S72.025M S72.025N S72.025P
S72.025Q S72.025R S72.031K S72.031M S72.031N S72.031P S72.031Q
S72.031R S72.032K S72.032M S72.032N S72.032P S72.032Q S72.032R
S72.034K S72.034M S72.034N S72.034P S72.034Q S72.034R S72.035K
S72.035M S72.035N S72.035P S72.035Q S72.035R S72.041K S72.041M
S72.041N S72.041P S72.041Q S72.041R S72.042K S72.042M S72.042N
S72.042P S72.042Q S72.042R S72.044K S72.044M S72.044N S72.044P
S72.044Q S72.044R S72.045K S72.045M S72.045N S72.045P S72.045Q
S72.045R S72.051K S72.051M S72.051N S72.051P S72.051Q S72.051R
S72.052K S72.052M S72.052N S72.052P S72.052Q S72.052R S72.061K
S72.061M S72.061N S72.061P S72.061Q S72.061R S72.062K S72.062M
S72.062N S72.062P S72.062Q S72.062R S72.064K S72.064M S72.064N
S72.064P S72.064Q S72.064R S72.065K S72.065M S72.065N S72.065P
S72.065Q S72.065R S72.091K S72.091M S72.091N S72.091P S72.091Q
S72.091R S72.092K S72.092M S72.092N S72.092P S72.092Q S72.092R
S72.101K S72.101M S72.101N S72.101P S72.101Q S72.101R S72.102K
S72.102M S72.102N S72.102P S72.102Q S72.102R S72.111K S72.111M
S72.111N S72.111P S72.111Q S72.111R S72.112K S72.112M S72.112N
S72.112P S72.112Q S72.112R S72.114K S72.114M S72.114N S72.114P
S72.114Q S72.114R S72.115K S72.115M S72.115N S72.115P S72.115Q
S72.115R S72.121K S72.121M S72.121N S72.121P S72.121Q S72.121R
S72.122K S72.122M S72.122N S72.122P S72.122Q S72.122R S72.124K
S72.124M S72.124N S72.124P S72.124Q S72.124R S72.125K S72.125M
S72.125N S72.125P S72.125Q S72.125R S72.131K S72.131M S72.131N
S72.131P S72.131Q S72.131R S72.132K S72.132M S72.132N S72.132P
S72.132Q S72.132R S72.134K S72.134M S72.134N S72.134P S72.134Q
S72.134R S72.135K S72.135M S72.135N S72.135P S72.135Q S72.135R
S72.141K S72.141M S72.141N S72.141P S72.141Q S72.141R S72.142K
S72.142M S72.142N S72.142P S72.142Q S72.142R S72.144K S72.144M
S72.144N S72.144P S72.144Q S72.144R S72.145K S72.145M S72.145N
S72.145P S72.145Q S72.145R S72.21XK S72.21XM S72.21XN S72.21XP
S72.21XQ S72.21XR S72.22XK S72.22XM S72.22XN S72.22XP S72.22XQ
S72.22XR S72.24XK S72.24XM S72.24XN S72.24XP S72.24XQ S72.24XR
S72.25XK S72.25XM S72.25XN S72.25XP S72.25XQ S72.25XR S72.301K
S72.301M S72.301N S72.301P S72.301Q S72.301R S72.301S S72.302K
S72.302M S72.302N S72.302P S72.302Q S72.302R S72.302S S72.321K
S72.321M S72.321N S72.321P S72.321Q S72.321R S72.321S S72.322K
S72.322M S72.322N S72.322P S72.322Q S72.322R S72.322S S72.324K
S72.324M S72.324N S72.324P S72.324Q S72.324R S72.324S S72.325K
S72.325M S72.325N S72.325P S72.325Q S72.325R S72.325S S72.331K
S72.331M S72.331N S72.331P S72.331Q S72.331R S72.331S S72.332K
S72.332M S72.332N S72.332P S72.332Q S72.332R S72.332S S72.334K
S72.334M S72.334N S72.334P S72.334Q S72.334R S72.334S S72.335K
S72.335M S72.335N S72.335P S72.335Q S72.335R S72.335S S72.341K
S72.341M S72.341N S72.341P S72.341Q S72.341R S72.341S S72.342K
S72.342M S72.342N S72.342P S72.342Q S72.342R S72.342S S72.344K
S72.344M S72.344N S72.344P S72.344Q S72.344R S72.344S S72.345K
S72.345M S72.345N S72.345P S72.345Q S72.345R S72.345S S72.351K
S72.351M S72.351N S72.351P S72.351Q S72.351R S72.351S S72.352K
S72.352M S72.352N S72.352P S72.352Q S72.352R S72.352S S72.354K
S72.354M S72.354N S72.354P S72.354Q S72.354R S72.354S S72.355K
S72.355M S72.355N S72.355P S72.355Q S72.355R S72.355S S72.361K
S72.361M S72.361N S72.361P S72.361Q S72.361R S72.361S S72.362K
S72.362M S72.362N S72.362P S72.362Q S72.362R S72.362S S72.364K
S72.364M S72.364N S72.364P S72.364Q S72.364R S72.364S S72.365K
S72.365M S72.365N S72.365P S72.365Q S72.365R S72.365S S72.391K
S72.391M S72.391N S72.391P S72.391Q S72.391R S72.391S S72.392K
S72.392M S72.392N S72.392P S72.392Q S72.392R S72.392S S72.401A
S72.401B S72.401C S72.401K S72.401M S72.401N S72.401P S72.401Q
S72.401R S72.401S S72.402A S72.402B S72.402C S72.402K S72.402M
S72.402N S72.402P S72.402Q S72.402R S72.402S S72.411A S72.411B
S72.411C S72.411K S72.411M S72.411N S72.411P S72.411Q S72.411R
S72.411S S72.412A S72.412B S72.412C S72.412K S72.412M S72.412N
S72.412P S72.412Q S72.412R S72.412S S72.414A S72.414B S72.414C
S72.414K S72.414M S72.414N S72.414P S72.414Q S72.414R S72.414S
S72.415A S72.415B S72.415C S72.415K S72.415M S72.415N S72.415P
S72.415Q S72.415R S72.415S S72.421A S72.421B S72.421C S72.421K
S72.421M S72.421N S72.421P S72.421Q S72.421R S72.421S S72.422A
S72.422B S72.422C S72.422K S72.422M S72.422N S72.422P S72.422Q
S72.422R S72.422S S72.424A S72.424B S72.424C S72.424K S72.424M
S72.424N S72.424P S72.424Q S72.424R S72.424S S72.425A S72.425B
S72.425C S72.425K S72.425M S72.425N S72.425P S72.425Q S72.425R
S72.425S S72.426B S72.426C S72.431A S72.431B S72.431C S72.431K
S72.431M S72.431N S72.431P S72.431Q S72.431R S72.431S S72.432A
S72.432B S72.432C S72.432K S72.432M S72.432N S72.432P S72.432Q
S72.432R S72.432S S72.434A S72.434B S72.434C S72.434K S72.434M
S72.434N S72.434P S72.434Q S72.434R S72.434S S72.435A S72.435B
S72.435C S72.435K S72.435M S72.435N S72.435P S72.435Q S72.435R
S72.435S S72.441A S72.441B S72.441C S72.441K S72.441M S72.441N
S72.441P S72.441Q S72.441R S72.441S S72.442A S72.442B S72.442C
S72.442K S72.442M S72.442N S72.442P S72.442Q S72.442R S72.442S
S72.444A S72.444B S72.444C S72.444K S72.444M S72.444N S72.444P
S72.444Q S72.444R S72.444S S72.445A S72.445B S72.445C S72.445K
S72.445M S72.445N S72.445P S72.445Q S72.445R S72.445S S72.451A
S72.451B S72.451C S72.451K S72.451M S72.451N S72.451P S72.451Q
S72.451R S72.451S S72.452A S72.452B S72.452C S72.452K S72.452M
S72.452N S72.452P S72.452Q S72.452R S72.452S S72.454A S72.454B
S72.454C S72.454K S72.454M S72.454N S72.454P S72.454Q S72.454R
S72.454S S72.455A S72.455B S72.455C S72.455K S72.455M S72.455N
S72.455P S72.455Q S72.455R S72.455S S72.461A S72.461B S72.461C
S72.461K S72.461M S72.461N S72.461P S72.461Q S72.461R S72.461S
S72.462A S72.462B S72.462C S72.462K S72.462M S72.462N S72.462P
S72.462Q S72.462R S72.462S S72.464A S72.464B S72.464C S72.464K
S72.464M S72.464N S72.464P S72.464Q S72.464R S72.464S S72.465A
S72.465B S72.465C S72.465K S72.465M S72.465N S72.465P S72.465Q
S72.465R S72.465S S72.471A S72.471K S72.471P S72.471S S72.472A
S72.472K S72.472P S72.472S S72.491A S72.491B S72.491C S72.491K
S72.491M S72.491N S72.491P S72.491Q S72.491R S72.491S S72.492A
S72.492B S72.492C S72.492K S72.492M S72.492N S72.492P S72.492Q
S72.492R S72.492S S72.8X1K S72.8X1M S72.8X1N S72.8X1P S72.8X1Q
S72.8X1R S72.8X1S S72.8X2K S72.8X2M S72.8X2N S72.8X2P S72.8X2Q
S72.8X2R S72.8X2S S72.91XK S72.91XM S72.91XN S72.91XP S72.91XQ
S72.91XR S72.91XS S72.92XK S72.92XM S72.92XN S72.92XP S72.92XQ
S72.92XR S72.92XS S79.001K S79.001P S79.001S S79.002K S79.002P
S79.002S S79.011K S79.011P S79.011S S79.012K S79.012P S79.012S
S79.091K S79.091P S79.091S S79.092K S79.092P S79.092S S79.101A
S79.101K S79.101P S79.101S S79.102A S79.102K S79.102P S79.102S
S79.111A S79.111K S79.111P S79.111S S79.112A S79.112K S79.112P
S79.112S S79.121A S79.121K S79.121P S79.121S S79.122A S79.122K
S79.122P S79.122S S79.131A S79.131K S79.131P S79.131S S79.132A
S79.132K S79.132P S79.132S S79.141A S79.141K S79.141P S79.141S
S79.142A S79.142K S79.142P S79.142S S79.191A S79.191K S79.191P
S79.191S S79.192A S79.192K S79.192P S79.192S S82.001A S82.001B
S82.001C S82.001K S82.001M S82.001N S82.001P S82.001Q S82.001R
S82.001S S82.002A S82.002B S82.002C S82.002K S82.002M S82.002N
S82.002P S82.002Q S82.002R S82.002S S82.011A S82.011B S82.011C
S82.011K S82.011M S82.011N S82.011P S82.011Q S82.011R S82.011S
S82.012A S82.012B S82.012C S82.012K S82.012M S82.012N S82.012P
S82.012Q S82.012R S82.012S S82.014A S82.014B S82.014C S82.014K
S82.014M S82.014N S82.014P S82.014Q S82.014R S82.014S S82.015A
S82.015B S82.015C S82.015K S82.015M S82.015N S82.015P S82.015Q
S82.015R S82.015S S82.021A S82.021B S82.021C S82.021K S82.021M
S82.021N S82.021P S82.021Q S82.021R S82.021S S82.022A S82.022B
S82.022C S82.022K S82.022M S82.022N S82.022P S82.022Q S82.022R
S82.022S S82.024A S82.024B S82.024C S82.024K S82.024M S82.024N
S82.024P S82.024Q S82.024R S82.024S S82.025A S82.025B S82.025C
S82.025K S82.025M S82.025N S82.025P S82.025Q S82.025R S82.025S
S82.031A S82.031B S82.031C S82.031K S82.031M S82.031N S82.031P
S82.031Q S82.031R S82.031S S82.032A S82.032B S82.032C S82.032K
S82.032M S82.032N S82.032P S82.032Q S82.032R S82.032S S82.034A
S82.034B S82.034C S82.034K S82.034M S82.034N S82.034P S82.034Q
S82.034R S82.034S S82.035A S82.035B S82.035C S82.035K S82.035M
S82.035N S82.035P S82.035Q S82.035R S82.035S S82.041A S82.041B
S82.041C S82.041K S82.041M S82.041N S82.041P S82.041Q S82.041R
S82.041S S82.042A S82.042B S82.042C S82.042K S82.042M S82.042N
S82.042P S82.042Q S82.042R S82.042S S82.044A S82.044B S82.044C
S82.044K S82.044M S82.044N S82.044P S82.044Q S82.044R S82.044S
S82.045A S82.045B S82.045C S82.045K S82.045M S82.045N S82.045P
S82.045Q S82.045R S82.045S S82.091A S82.091B S82.091C S82.091K
S82.091M S82.091N S82.091P S82.091Q S82.091R S82.091S S82.092A
S82.092B S82.092C S82.092K S82.092M S82.092N S82.092P S82.092Q
S82.092R S82.092S S82.101A S82.101B S82.101C S82.101K S82.101M
S82.101N S82.101P S82.101Q S82.101R S82.101S S82.102A S82.102B
S82.102C S82.102K S82.102M S82.102N S82.102P S82.102Q S82.102R
S82.102S S82.111A S82.111B S82.111C S82.111K S82.111M S82.111N
S82.111P S82.111Q S82.111R S82.111S S82.112A S82.112B S82.112C
S82.112K S82.112M S82.112N S82.112P S82.112Q S82.112R S82.112S
S82.114A S82.114B S82.114C S82.114K S82.114M S82.114N S82.114P
S82.114Q S82.114R S82.114S S82.115A S82.115B S82.115C S82.115K
S82.115M S82.115N S82.115P S82.115Q S82.115R S82.115S S82.121A
S82.121B S82.121C S82.121K S82.121M S82.121N S82.121P S82.121Q
S82.121R S82.121S S82.122A S82.122B S82.122C S82.122K S82.122M
S82.122N S82.122P S82.122Q S82.122S S82.124A S82.124B S82.124C
S82.124K S82.124M S82.124N S82.124P S82.124Q S82.124R S82.124S
S82.125A S82.125B S82.125C S82.125K S82.125M S82.125N S82.125P
S82.125Q S82.125R S82.125S S82.131A S82.131B S82.131C S82.131K
S82.131M S82.131N S82.131P S82.131Q S82.131R S82.131S S82.132A
S82.132B S82.132C S82.132K S82.132M S82.132N S82.132P S82.132Q
S82.132R S82.132S S82.134A S82.134B S82.134C S82.134K S82.134M
S82.134N S82.134P S82.134Q S82.134R S82.134S S82.135A S82.135B
S82.135C S82.135K S82.135M S82.135N S82.135P S82.135Q S82.135R
S82.135S S82.141A S82.141B S82.141C S82.141K S82.141M S82.141N
S82.141P S82.141Q S82.141R S82.141S S82.142A S82.142B S82.142C
S82.142K S82.142M S82.142N S82.142P S82.142Q S82.142R S82.142S
S82.144A S82.144B S82.144C S82.144K S82.144M S82.144N S82.144P
S82.144Q S82.144R S82.144S S82.145A S82.145B S82.145C S82.145K
S82.145M S82.145N S82.145P S82.145Q S82.145R S82.145S S82.151A
S82.151B S82.151C S82.151K S82.151M S82.151N S82.151P S82.151Q
S82.151R S82.151S S82.152A S82.152B S82.152C S82.152K S82.152M
S82.152N S82.152P S82.152Q S82.152R S82.152S S82.154A S82.154B
S82.154C S82.154K S82.154M S82.154N S82.154P S82.154Q S82.154R
S82.154S S82.155A S82.155B S82.155C S82.155K S82.155M S82.155N
S82.155P S82.155Q S82.155R S82.155S S82.161A S82.161K S82.161P
S82.161S S82.162A S82.162K S82.162P S82.162S S82.191A S82.191B
S82.191C S82.191K S82.191M S82.191N S82.191P S82.191Q S82.191R
S82.191S S82.192A S82.192B S82.192C S82.192K S82.192M S82.192N
S82.192P S82.192Q S82.192R S82.192S S82.201A S82.201B S82.201C
S82.201K S82.201M S82.201N S82.201P S82.201Q S82.201R S82.201S
S82.202A S82.202B S82.202C S82.202K S82.202M S82.202N S82.202P
S82.202Q S82.202R S82.202S S82.221A S82.221B S82.221C S82.221K
S82.221M S82.221N S82.221P S82.221Q S82.221R S82.221S S82.222A
S82.222B S82.222C S82.222K S82.222M S82.222N S82.222P S82.222Q
S82.222R S82.222S S82.224A S82.224B S82.224C S82.224K S82.224M
S82.224N S82.224P S82.224Q S82.224R S82.224S S82.225A S82.225B
S82.225C S82.225K S82.225M S82.225N S82.225P S82.225Q S82.225R
S82.225S S82.231A S82.231B S82.231C S82.231K S82.231M S82.231N
S82.231P S82.231Q S82.231R S82.231S S82.232A S82.232B S82.232C
S82.232K S82.232M S82.232N S82.232P S82.232Q S82.232R S82.232S
S82.234A S82.234B S82.234C S82.234K S82.234M S82.234N S82.234P
S82.234Q S82.234R S82.234S S82.235A S82.235B S82.235C S82.235K
S82.235M S82.235N S82.235P S82.235Q S82.235R S82.235S S82.241A
S82.241B S82.241C S82.241K S82.241M S82.241N S82.241P S82.241Q
S82.241R S82.241S S82.242A S82.242B S82.242C S82.242K S82.242M
S82.242N S82.242P S82.242Q S82.242R S82.242S S82.244A S82.244B
S82.244C S82.244K S82.244M S82.244N S82.244P S82.244Q S82.244R
S82.244S S82.245A S82.245B S82.245C S82.245K S82.245M S82.245N
S82.245P S82.245Q S82.245R S82.245S S82.251A S82.251B S82.251C
S82.251K S82.251M S82.251N S82.251P S82.251Q S82.251R S82.251S
S82.252A S82.252B S82.252C S82.252K S82.252M S82.252N S82.252P
S82.252Q S82.252R S82.252S S82.254A S82.254B S82.254C S82.254K
S82.254M S82.254N S82.254P S82.254Q S82.254R S82.254S S82.255A
S82.255B S82.255C S82.255K S82.255M S82.255N S82.255P S82.255Q
S82.255R S82.255S S82.261A S82.261B S82.261C S82.261K S82.261M
S82.261N S82.261P S82.261Q S82.261R S82.261S S82.262A S82.262B
S82.262C S82.262K S82.262M S82.262N S82.262P S82.262Q S82.262R
S82.262S S82.264A S82.264B S82.264C S82.264K S82.264M S82.264N
S82.264P S82.264Q S82.264R S82.264S S82.265A S82.265B S82.265C
S82.265K S82.265M S82.265N S82.265P S82.265Q S82.265R S82.265S
S82.291A S82.291B S82.291C S82.291K S82.291M S82.291N S82.291P
S82.291Q S82.291R S82.291S S82.292A S82.292B S82.292C S82.292K
S82.292M S82.292N S82.292P S82.292Q S82.292R S82.292S S82.301K
S82.301M S82.301N S82.301P S82.301Q S82.301R S82.301S S82.302K
S82.302M S82.302N S82.302P S82.302Q S82.302R S82.302S S82.311A
S82.311K S82.311P S82.311S S82.312A S82.312K S82.312P S82.312S
S82.391K S82.391M S82.391N S82.391P S82.391Q S82.391R S82.391S
S82.392K S82.392M S82.392N S82.392P S82.392Q S82.392R S82.392S
S82.401A S82.401B S82.401C S82.401K S82.401M S82.401N S82.401P
S82.401Q S82.401R S82.401S S82.402A S82.402B S82.402C S82.402K
S82.402M S82.402N S82.402P S82.402Q S82.402R S82.402S S82.421A
S82.421B S82.421C S82.421K S82.421M S82.421N S82.421P S82.421Q
S82.421R S82.421S S82.422A S82.422B S82.422C S82.422K S82.422M
S82.422N S82.422P S82.422Q S82.422R S82.422S S82.424A S82.424B
S82.424C S82.424K S82.424M S82.424N S82.424P S82.424Q S82.424R
S82.424S S82.425A S82.425B S82.425C S82.425K S82.425M S82.425N
S82.425P S82.425Q S82.425R S82.425S S82.431A S82.431B S82.431C
S82.431K S82.431M S82.431N S82.431P S82.431Q S82.431R S82.431S
S82.432A S82.432B S82.432C S82.432K S82.432M S82.432N S82.432P
S82.432Q S82.432R S82.432S S82.434A S82.434B S82.434C S82.434K
S82.434M S82.434N S82.434P S82.434Q S82.434R S82.434S S82.435A
S82.435B S82.435C S82.435K S82.435M S82.435N S82.435P S82.435Q
S82.435R S82.435S S82.441A S82.441B S82.441C S82.441K S82.441M
S82.441N S82.441P S82.441Q S82.441R S82.441S S82.442A S82.442B
S82.442C S82.442K S82.442M S82.442N S82.442P S82.442Q S82.442R
S82.442S S82.444A S82.444B S82.444C S82.444K S82.444M S82.444N
S82.444P S82.444Q S82.444R S82.444S S82.445A S82.445B S82.445C
S82.445K S82.445M S82.445N S82.445P S82.445Q S82.445R S82.445S
S82.451A S82.451B S82.451C S82.451K S82.451M S82.451N S82.451P
S82.451Q S82.451R S82.451S S82.452A S82.452B S82.452C S82.452K
S82.452M S82.452N S82.452P S82.452Q S82.452R S82.452S S82.454A
S82.454B S82.454C S82.454K S82.454M S82.454N S82.454P S82.454Q
S82.454R S82.454S S82.455A S82.455B S82.455C S82.455K S82.455M
S82.455N S82.455P S82.455Q S82.455R S82.455S S82.461A S82.461B
S82.461C S82.461K S82.461M S82.461N S82.461P S82.461Q S82.461R
S82.461S S82.462A S82.462B S82.462C S82.462K S82.462M S82.462N
S82.462P S82.462Q S82.462R S82.462S S82.464A S82.464B S82.464C
S82.464K S82.464M S82.464N S82.464P S82.464Q S82.464R S82.464S
S82.465A S82.465B S82.465C S82.465K S82.465M S82.465N S82.465P
S82.465Q S82.465R S82.465S S82.491A S82.491B S82.491C S82.491K
S82.491M S82.491N S82.491P S82.491Q S82.491R S82.491S S82.492A
S82.492B S82.492C S82.492K S82.492M S82.492N S82.492P S82.492Q
S82.492R S82.492S S82.51XK S82.51XM S82.51XN S82.51XP S82.51XQ
S82.51XR S82.51XS S82.52XK S82.52XM S82.52XN S82.52XP S82.52XQ
S82.52XR S82.52XS S82.54XK S82.54XM S82.54XN S82.54XP S82.54XQ
S82.54XR S82.54XS S82.55XK S82.55XM S82.55XN S82.55XP S82.55XQ
S82.55XR S82.55XS S82.61XK S82.61XM S82.61XN S82.61XP S82.61XQ
S82.61XR S82.61XS S82.62XK S82.62XM S82.62XN S82.62XP S82.62XQ
S82.62XR S82.62XS S82.64XK S82.64XM S82.64XN S82.64XP S82.64XQ
S82.64XR S82.64XS S82.65XK S82.65XM S82.65XN S82.65XP S82.65XQ
S82.65XR S82.65XS S82.811A S82.811K S82.811P S82.811S S82.812A
S82.812K S82.812P S82.812S S82.821A S82.821K S82.821P S82.821S
S82.822A S82.822K S82.822P S82.822S S82.831A S82.831B S82.831C
S82.831K S82.831M S82.831N S82.831P S82.831Q S82.831R S82.831S
S82.832A S82.832B S82.832C S82.832K S82.832M S82.832N S82.832P
S82.832Q S82.832R S82.832S S82.841K S82.841M S82.841N S82.841P
S82.841Q S82.841R S82.841S S82.842K S82.842M S82.842N S82.842P
S82.842Q S82.842R S82.842S S82.844K S82.844M S82.844N S82.844P
S82.844Q S82.844R S82.844S S82.845K S82.845M S82.845N S82.845P
S82.845Q S82.845R S82.845S S82.851K S82.851M S82.851N S82.851P
S82.851Q S82.851R S82.851S S82.852K S82.852M S82.852N S82.852P
S82.852Q S82.852R S82.852S S82.854K S82.854M S82.854N S82.854P
S82.854Q S82.854R S82.854S S82.855K S82.855M S82.855N S82.855P
S82.855Q S82.855R S82.855S S82.861A S82.861B S82.861C S82.861K
S82.861M S82.861N S82.861P S82.861Q S82.861R S82.861S S82.862A
S82.862B S82.862C S82.862K S82.862M S82.862N S82.862P S82.862Q
S82.862R S82.862S S82.864A S82.864B S82.864C S82.864K S82.864M
S82.864N S82.864P S82.864Q S82.864R S82.864S S82.865A S82.865B
S82.865C S82.865K S82.865M S82.865N S82.865P S82.865Q S82.865R
S82.865S S82.871K S82.871M S82.871N S82.871P S82.871Q S82.871R
S82.871S S82.872K S82.872M S82.872N S82.872P S82.872Q S82.872R
S82.872S S82.874K S82.874M S82.874N S82.874P S82.874Q S82.874R
S82.874S S82.875K S82.875M S82.875N S82.875P S82.875Q S82.875R
S82.875S S82.891K S82.891M S82.891N S82.891P S82.891Q S82.891R
S82.891S S82.892K S82.892M S82.892N S82.892P S82.892Q S82.892R
S82.892S S82.91XK S82.91XM S82.91XN S82.91XS S82.92XK S82.92XM
S82.92XN S82.92XS S83.001A S83.002A S83.004A S83.005A S83.011A
S83.012A S83.014A S83.015A S83.091A S83.092A S83.094A S83.095A
S83.101A S83.102A S83.104A S83.105A S83.111A S83.112A S83.114A
S83.115A S83.121A S83.122A S83.124A S83.125A S83.131A S83.132A
S83.134A S83.135A S83.141A S83.142A S83.144A S83.145A S83.191A
S83.192A S83.194A S83.195A S83.200A S83.201A S83.203A S83.204A
S83.206A S83.207A S83.211A S83.212A S83.221A S83.222A S83.231A
S83.232A S83.241A S83.242A S83.251A S83.252A S83.261A S83.262A
S83.271A S83.272A S83.281A S83.282A S83.31XA S83.32XA S83.401A
S83.402A S83.411A S83.412A S83.421A S83.422A S83.501A S83.502A
S83.511A S83.512A S83.521A S83.522A S83.8X1A S83.8X2A S86.111A
S86.112A S86.211A S86.212A S86.311A S86.312A S86.811A S86.812A
S89.001A S89.001K S89.001P S89.001S S89.002A S89.002K S89.002P
S89.002S S89.011A S89.011K S89.011P S89.011S S89.012A S89.012K
S89.012P S89.012S S89.021A S89.021K S89.021P S89.021S S89.022A
S89.022K S89.022P S89.022S S89.031A S89.031K S89.031P S89.031S
S89.032A S89.032K S89.032P S89.032S S89.041A S89.041K S89.041P
S89.041S S89.042A S89.042K S89.042P S89.042S S89.091A S89.091K
S89.091P S89.091S S89.092A S89.092K S89.092P S89.092S S89.101K
S89.101P S89.101S S89.102K S89.102P S89.102S S89.111K S89.111P
S89.111S S89.112K S89.112P S89.112S S89.121K S89.121P S89.121S
S89.122K S89.122P S89.122S S89.131K S89.131P S89.131S S89.132K
S89.132P S89.132S S89.141K S89.141P S89.141S S89.142K S89.142P
S89.142S S89.191K S89.191P S89.191S S89.192K S89.192P S89.192S
S89.201A S89.201K S89.201P S89.201S S89.202A S89.202K S89.202P
S89.202S S89.211A S89.211K S89.211P S89.211S S89.212A S89.212K
S89.212P S89.212S S89.221A S89.221K S89.221P S89.221S S89.222A
S89.222K S89.222P S89.222S S89.291A S89.291K S89.291P S89.291S
S89.292A S89.292K S89.292P S89.292S S89.301K S89.301P S89.301S
S89.302K S89.302P S89.302S S89.311K S89.311P S89.311S S89.312K
S89.312P S89.312S S89.321K S89.321P S89.321S S89.322K S89.322P
S89.322S S89.391K S89.391P S89.391S S89.392K S89.392P S89.392S
T84.012A T84.013A T84.022A T84.023A T84.032A T84.033A T84.042A
T84.043A T84.052A T84.053A T84.062A T84.063A T84.092A T84.093A
T84.114A T84.115A T84.116A T84.117A T84.124A T84.125A T84.126A
T84.127A T84.194A T84.195A T84.196A T84.197A T84.410A T84.420A
T84.498A T84.53XA T84.54XA T84.81XA T84.82XA T84.83XA T84.84XA
T84.85XA T84.86XA T84.89XA Z96.651 Z96.652 Z96.653

Covered Diagnosis Codes for Procedure Code L1840

G80.0 G80.1 G80.2 G80.3 G80.4 G80.8 G80.9
M22.2X1 M22.2X2 M22.3X1 M22.3X2 M22.8X1 M22.8X2 M22.91
M22.92 M23.51 M23.52 M23.601 M23.602 M23.611 M23.612
M23.621 M23.622 M23.631 M23.632 M23.641 M23.642 M23.671
M23.672 M23.8X1 M23.8X2 M23.91 M23.92

Covered Diagnosis codes for Procedure Codes A9285, L1832, L1833, L1843, L1844, L1845, L1846, L1851 and L1852

G04.1 G35 G57.01 G57.02 G57.21 G57.22 G80.0
G80.1 G80.2 G80.3 G80.4 G80.8 G80.9 G81.91
G81.92 G81.93 G81.94 G82.20 G82.21 G82.22 M05.061
M05.062 M05.261 M05.262 M05.361 M05.362 M05.461 M05.462
M05.561 M05.562 M05.661 M05.662 M05.761 M05.762 M05.861
M05.862 M06.061 M06.062 M06.1 M06.261 M06.262 M06.361
M06.362 M06.861 M06.862 M08.061 M08.062 M08.261 M08.262
M08.3 M08.461 M08.462 M08.861 M08.862 M08.961 M08.962
M12.061 M12.062 M17.0 M17.11 M17.12 M17.2 M17.31
M17.32 M17.4 M17.5 M17.9 M22.2X1 M22.2X2 M22.3X1
M22.3X2 M22.41 M22.42 M22.8X1 M22.8X2 M22.91 M22.92
M23.000 M23.001 M23.003 M23.004 M23.006 M23.007 M23.011
M23.012 M23.021 M23.022 M23.031 M23.032 M23.041 M23.042
M23.051 M23.052 M23.061 M23.062 M23.200 M23.201 M23.203
M23.204 M23.206 M23.207 M23.211 M23.212 M23.221 M23.222
M23.231 M23.232 M23.241 M23.242 M23.251 M23.252 M23.261
M23.262 M23.300 M23.301 M23.303 M23.304 M23.306 M23.307
M23.311 M23.312 M23.321 M23.322 M23.331 M23.332 M23.341
M23.342 M23.351 M23.352 M23.361 M23.362 M23.51 M23.52
M23.601 M23.602 M23.611 M23.612 M23.621 M23.622 M23.631
M23.632 M23.641 M23.642 M23.671 M23.672 M23.8X1 M23.8X2
M23.91 M23.92 M66.251 M66.252 M66.261 M66.262 M80.051A
M80.051K M80.051P M80.052A M80.052K M80.052P M80.061A M80.061K
M80.061P M80.061S M80.062A M80.062K M80.062P M80.851A M80.851K
M80.851P M80.851S M80.852A M80.852K M80.852P M80.852S M80.861A
M80.861K M80.861P M80.861S M80.862A M80.862K M80.862P M80.862S
M84.351P M84.351S M84.352P M84.352S M84.361A M84.361K M84.361P
M84.361S M84.362A M84.362K M84.362P M84.362S M84.363A M84.363K
M84.363P M84.363S M84.364A M84.364K M84.364P M84.364S M84.451A
M84.451K M84.451P M84.451S M84.452A M84.452K M84.452P M84.452S
M84.461A M84.461K M84.461P M84.461S M84.462A M84.462K M84.462P
M84.462S M84.463A M84.463K M84.463P M84.463S M84.464A M84.464K
M84.464P M84.464S M84.551A M84.551K M84.551P M84.551S M84.552A
M84.552K M84.552P M84.552S M84.561A M84.561K M84.561P M84.561S
M84.562A M84.562K M84.562P M84.562S M84.563A M84.563K M84.563P
M84.563S M84.564A M84.564K M84.564P M84.564S M84.651A M84.651K
M84.651P M84.651S M84.652A M84.652K M84.652P M84.652S M84.661A
M84.661K M84.661P M84.661S M84.662A M84.662K M84.662P M84.662S
M84.663A M84.663K M84.663P M84.663S M84.664A M84.664K M84.664P
M84.664S M87.061 M87.062 M87.064 M87.065 M87.161 M87.162
M87.164 M87.165 M87.261 M87.262 M87.264 M87.265 M87.361
M87.362 M87.364 M87.365 M87.861 M87.862 M87.864 M87.865
M90.561 M90.562 M96.661 M96.662 M96.671 M96.672 Q68.2
Q68.6 Q74.1 S72.001K S72.001M S72.001N S72.001P S72.001Q
S72.001R S72.002K S72.002M S72.002N S72.002P S72.002Q S72.002R
S72.011K S72.011M S72.011N S72.011P S72.011Q S72.011R S72.012K
S72.012M S72.012N S72.012P S72.012Q S72.012R S72.021K S72.021M
S72.021N S72.021P S72.021Q S72.021R S72.022K S72.022M S72.022N
S72.022P S72.022Q S72.022R S72.024K S72.024M S72.024N S72.024P
S72.024Q S72.024R S72.025K S72.025M S72.025N S72.025P S72.025Q
S72.025R S72.031K S72.031M S72.031N S72.031P S72.031Q S72.031R
S72.032K S72.032M S72.032N S72.032P S72.032Q S72.032R S72.034K
S72.034M S72.034N S72.034P S72.034Q S72.034R S72.035K S72.035M
S72.035N S72.035P S72.035Q S72.035R S72.041K S72.041M S72.041N
S72.041P S72.041Q S72.041R S72.042K S72.042M S72.042N S72.042P
S72.042Q S72.042R S72.044K S72.044M S72.044N S72.044P S72.044Q
S72.044R S72.045K S72.045M S72.045N S72.045P S72.045Q S72.045R
S72.051K S72.051M S72.051N S72.051P S72.051Q S72.051R S72.052K
S72.052M S72.052N S72.052P S72.052Q S72.052R S72.061K S72.061M
S72.061N S72.061P S72.061Q S72.061R S72.062K S72.062M S72.062N
S72.062P S72.062Q S72.062R S72.064K S72.064M S72.064N S72.064P
S72.064Q S72.064R S72.065K S72.065M S72.065N S72.065P S72.065Q
S72.065R S72.091K S72.091M S72.091N S72.091P S72.091Q S72.091R
S72.092K S72.092M S72.092N S72.092P S72.092Q S72.092R S72.101K
S72.101M S72.101N S72.101P S72.101Q S72.101R S72.102K S72.102M
S72.102N S72.102P S72.102Q S72.102R S72.111K S72.111M S72.111N
S72.111P S72.111Q S72.111R S72.112K S72.112M S72.112N S72.112P
S72.112Q S72.112R S72.114K S72.114M S72.114N S72.114P S72.114Q
S72.114R S72.115K S72.115M S72.115N S72.115P S72.115Q S72.115R
S72.121K S72.121M S72.121N S72.121P S72.121Q S72.121R S72.122K
S72.122M S72.122N S72.122P S72.122Q S72.122R S72.124K S72.124M
S72.124N S72.124P S72.124Q S72.124R S72.125K S72.125M S72.125N
S72.125P S72.125Q S72.125R S72.131K S72.131M S72.131N S72.131P
S72.131Q S72.131R S72.132K S72.132M S72.132N S72.132P S72.132Q
S72.132R S72.134K S72.134M S72.134N S72.134P S72.134Q S72.134R
S72.135K S72.135M S72.135N S72.135P S72.135Q S72.135R S72.141K
S72.141M S72.141N S72.141P S72.141Q S72.141R S72.142K S72.142M
S72.142N S72.142P S72.142Q S72.142R S72.144K S72.144M S72.144N
S72.144P S72.144Q S72.144R S72.145K S72.145M S72.145N S72.145P
S72.145Q S72.145R S72.21XK S72.21XM S72.21XN S72.21XP S72.21XQ
S72.21XR S72.22XK S72.22XM S72.22XN S72.22XP S72.22XQ S72.22XR
S72.24XK S72.24XM S72.24XN S72.24XP S72.24XQ S72.24XR S72.25XK
S72.25XM S72.25XN S72.25XP S72.25XQ S72.25XR S72.301K S72.301M
S72.301N S72.301P S72.301Q S72.301R S72.301S S72.302K S72.302M
S72.302N S72.302P S72.302Q S72.302R S72.302S S72.321K S72.321M
S72.321N S72.321P S72.321Q S72.321R S72.321S S72.322K S72.322M
S72.322N S72.322P S72.322Q S72.322R S72.322S S72.324K S72.324M
S72.324N S72.324P S72.324Q S72.324R S72.324S S72.325K S72.325M
S72.325N S72.325P S72.325Q S72.325R S72.325S S72.331K S72.331M
S72.331N S72.331P S72.331Q S72.331R S72.331S S72.332K S72.332M
S72.332N S72.332P S72.332Q S72.332R S72.332S S72.334K S72.334M
S72.334N S72.334P S72.334Q S72.334R S72.334S S72.335K S72.335M
S72.335N S72.335P S72.335Q S72.335R S72.335S S72.341K S72.341M
S72.341N S72.341P S72.341Q S72.341R S72.341S S72.342K S72.342M
S72.342N S72.342P S72.342Q S72.342R S72.342S S72.344K S72.344M
S72.344N S72.344P S72.344Q S72.344R S72.344S S72.345K S72.345M
S72.345N S72.345P S72.345Q S72.345R S72.345S S72.351K S72.351M
S72.351N S72.351P S72.351Q S72.351R S72.351S S72.352K S72.352M
S72.352N S72.352P S72.352Q S72.352R S72.352S S72.354K S72.354M
S72.354N S72.354P S72.354Q S72.354R S72.354S S72.355K S72.355M
S72.355N S72.355P S72.355Q S72.355R S72.355S S72.361K S72.361M
S72.361N S72.361P S72.361Q S72.361R S72.361S S72.362K S72.362M
S72.362N S72.362P S72.362Q S72.362R S72.362S S72.364K S72.364M
S72.364N S72.364P S72.364Q S72.364R S72.364S S72.365K S72.365M
S72.365N S72.365P S72.365Q S72.365R S72.365S S72.391K S72.391M
S72.391N S72.391P S72.391Q S72.391R S72.391S S72.392K S72.392M
S72.392N S72.392P S72.392Q S72.392R S72.392S S72.401A S72.401B
S72.401C S72.401K S72.401M S72.401N S72.401P S72.401Q S72.401R
S72.401S S72.402A S72.402B S72.402C S72.402K S72.402M S72.402N
S72.402P S72.402Q S72.402R S72.402S S72.411A S72.411B S72.411C
S72.411K S72.411M S72.411N S72.411P S72.411Q S72.411R S72.411S
S72.412A S72.412B S72.412C S72.412K S72.412M S72.412N S72.412P
S72.412Q S72.412R S72.412S S72.414A S72.414B S72.414C S72.414K
S72.414M S72.414N S72.414P S72.414Q S72.414R S72.414S S72.415A
S72.415B S72.415C S72.415K S72.415M S72.415N S72.415P S72.415Q
S72.415R S72.415S S72.421A S72.421B S72.421C S72.421K S72.421M
S72.421N S72.421P S72.421Q S72.421R S72.421S S72.422A S72.422B
S72.422C S72.422K S72.422M S72.422N S72.422P S72.422Q S72.422R
S72.422S S72.424A S72.424B S72.424C S72.424K S72.424M S72.424N
S72.424P S72.424Q S72.424R S72.424S S72.425A S72.425B S72.425C
S72.425K S72.425M S72.425N S72.425P S72.425Q S72.425R S72.425S
S72.426B S72.426C S72.431A S72.431B S72.431C S72.431K S72.431M
S72.431N S72.431P S72.431Q S72.431R S72.431S S72.432A S72.432B
S72.432C S72.432K S72.432M S72.432N S72.432P S72.432Q S72.432R
S72.432S S72.434A S72.434B S72.434C S72.434K S72.434M S72.434N
S72.434P S72.434Q S72.434R S72.434S S72.435A S72.435B S72.435C
S72.435K S72.435M S72.435N S72.435P S72.435Q S72.435R S72.435S
S72.441A S72.441B S72.441C S72.441K S72.441M S72.441N S72.441P
S72.441Q S72.441R S72.441S S72.442A S72.442B S72.442C S72.442K
S72.442M S72.442N S72.442P S72.442Q S72.442R S72.442S S72.444A
S72.444B S72.444C S72.444K S72.444M S72.444N S72.444P S72.444Q
S72.444R S72.444S S72.445A S72.445B S72.445C S72.445K S72.445M
S72.445N S72.445P S72.445Q S72.445R S72.445S S72.451A S72.451B
S72.451C S72.451K S72.451M S72.451N S72.451P S72.451Q S72.451R
S72.451S S72.452A S72.452B S72.452C S72.452K S72.452M S72.452N
S72.452P S72.452Q S72.452R S72.452S S72.454A S72.454B S72.454C
S72.454K S72.454M S72.454N S72.454P S72.454Q S72.454R S72.454S
S72.455A S72.455B S72.455C S72.455K S72.455M S72.455N S72.455P
S72.455Q S72.455R S72.455S S72.461A S72.461B S72.461C S72.461K
S72.461M S72.461N S72.461P S72.461Q S72.461R S72.461S S72.462A
S72.462B S72.462C S72.462K S72.462M S72.462N S72.462P S72.462Q
S72.462R S72.462S S72.464A S72.464B S72.464C S72.464K S72.464M
S72.464N S72.464P S72.464Q S72.464R S72.464S S72.465A S72.465B
S72.465C S72.465K S72.465M S72.465N S72.465P S72.465Q S72.465R
S72.465S S72.471A S72.471K S72.471P S72.471S S72.472A S72.472K
S72.472P S72.472S S72.491A S72.491B S72.491C S72.491K S72.491M
S72.491N S72.491P S72.491Q S72.491R S72.491S S72.492A S72.492B
S72.492C S72.492K S72.492M S72.492N S72.492P S72.492Q S72.492R
S72.492S S72.8X1K S72.8X1M S72.8X1N S72.8X1P S72.8X1Q S72.8X1R
S72.8X1S S72.8X2K S72.8X2M S72.8X2N S72.8X2P S72.8X2Q S72.8X2R
S72.8X2S S72.91XK S72.91XM S72.91XN S72.91XP S72.91XQ S72.91XR
S72.91XS S72.92XK S72.92XM S72.92XN S72.92XP S72.92XQ S72.92XR
S72.92XS S79.001K S79.001P S79.001S S79.002K S79.002P S79.002S
S79.011K S79.011P S79.011S S79.012K S79.012P S79.012S S79.091K
S79.091P S79.091S S79.092K S79.092P S79.092S S79.101A S79.101K
S79.101P S79.101S S79.102A S79.102K S79.102P S79.102S S79.111A
S79.111K S79.111P S79.111S S79.112A S79.112K S79.112P S79.112S
S79.121A S79.121K S79.121P S79.121S S79.122A S79.122K S79.122P
S79.122S S79.131A S79.131K S79.131P S79.131S S79.132A S79.132K
S79.132P S79.132S S79.141A S79.141K S79.141P S79.141S S79.142A
S79.142K S79.142P S79.142S S79.191A S79.191K S79.191P S79.191S
S79.192A S79.192K S79.192P S79.192S S82.001A S82.001B S82.001C
S82.001K S82.001M S82.001N S82.001P S82.001Q S82.001R S82.001S
S82.002A S82.002B S82.002C S82.002K S82.002M S82.002N S82.002P
S82.002Q S82.002R S82.002S S82.011A S82.011B S82.011C S82.011K
S82.011M S82.011N S82.011P S82.011Q S82.011R S82.011S S82.012A
S82.012B S82.012C S82.012K S82.012M S82.012N S82.012P S82.012Q
S82.012R S82.012S S82.014A S82.014B S82.014C S82.014K S82.014M
S82.014N S82.014P S82.014Q S82.014R S82.014S S82.015A S82.015B
S82.015C S82.015K S82.015M S82.015N S82.015P S82.015Q S82.015R
S82.015S S82.021A S82.021B S82.021C S82.021K S82.021M S82.021N
S82.021P S82.021Q S82.021R S82.021S S82.022A S82.022B S82.022C
S82.022K S82.022M S82.022N S82.022P S82.022Q S82.022R S82.022S
S82.024A S82.024B S82.024C S82.024K S82.024M S82.024N S82.024P
S82.024Q S82.024R S82.024S S82.025A S82.025B S82.025C S82.025K
S82.025M S82.025N S82.025P S82.025Q S82.025R S82.025S S82.031A
S82.031B S82.031C S82.031K S82.031M S82.031N S82.031P S82.031Q
S82.031R S82.031S S82.032A S82.032B S82.032C S82.032K S82.032M
S82.032N S82.032P S82.032Q S82.032R S82.032S S82.034A S82.034B
S82.034C S82.034K S82.034M S82.034N S82.034P S82.034Q S82.034R
S82.034S S82.035A S82.035B S82.035C S82.035K S82.035M S82.035N
S82.035P S82.035Q S82.035R S82.035S S82.041A S82.041B S82.041C
S82.041K S82.041M S82.041N S82.041P S82.041Q S82.041R S82.041S
S82.042A S82.042B S82.042C S82.042K S82.042M S82.042N S82.042P
S82.042Q S82.042R S82.042S S82.044A S82.044B S82.044C S82.044K
S82.044M S82.044N S82.044P S82.044Q S82.044R S82.044S S82.045A
S82.045B S82.045C S82.045K S82.045M S82.045N S82.045P S82.045Q
S82.045R S82.045S S82.091A S82.091B S82.091C S82.091K S82.091M
S82.091N S82.091P S82.091Q S82.091R S82.091S S82.092A S82.092B
S82.092C S82.092K S82.092M S82.092N S82.092P S82.092Q S82.092R
S82.092S S82.101A S82.101B S82.101C S82.101K S82.101M S82.101N
S82.101P S82.101Q S82.101R S82.101S S82.102A S82.102B S82.102C
S82.102K S82.102M S82.102N S82.102P S82.102Q S82.102R S82.102S
S82.111A S82.111B S82.111C S82.111K S82.111M S82.111N S82.111P
S82.111Q S82.111R S82.111S S82.112A S82.112B S82.112C S82.112K
S82.112M S82.112N S82.112P S82.112Q S82.112R S82.112S S82.114A
S82.114B S82.114C S82.114K S82.114M S82.114N S82.114P S82.114Q
S82.114R S82.114S S82.115A S82.115B S82.115C S82.115K S82.115M
S82.115N S82.115P S82.115Q S82.115R S82.115S S82.121A S82.121B
S82.121C S82.121K S82.121M S82.121N S82.121P S82.121Q S82.121R
S82.121S S82.122A S82.122B S82.122C S82.122K S82.122M S82.122N
S82.122P S82.122Q S82.122S S82.124A S82.124B S82.124C S82.124K
S82.124M S82.124N S82.124P S82.124Q S82.124R S82.124S S82.125A
S82.125B S82.125C S82.125K S82.125M S82.125N S82.125P S82.125Q
S82.125R S82.125S S82.131A S82.131B S82.131C S82.131K S82.131M
S82.131N S82.131P S82.131Q S82.131R S82.131S S82.132A S82.132B
S82.132C S82.132K S82.132M S82.132N S82.132P S82.132Q S82.132R
S82.132S S82.134A S82.134B S82.134C S82.134K S82.134M S82.134N
S82.134P S82.134Q S82.134R S82.134S S82.135A S82.135B S82.135C
S82.135K S82.135M S82.135N S82.135P S82.135Q S82.135R S82.135S
S82.141A S82.141B S82.141C S82.141K S82.141M S82.141N S82.141P
S82.141Q S82.141R S82.141S S82.142A S82.142B S82.142C S82.142K
S82.142M S82.142N S82.142P S82.142Q S82.142R S82.142S S82.144A
S82.144B S82.144C S82.144K S82.144M S82.144N S82.144P S82.144Q
S82.144R S82.144S S82.145A S82.145B S82.145C S82.145K S82.145M
S82.145N S82.145P S82.145Q S82.145R S82.145S S82.151A S82.151B
S82.151C S82.151K S82.151M S82.151N S82.151P S82.151Q S82.151R
S82.151S S82.152A S82.152B S82.152C S82.152K S82.152M S82.152N
S82.152P S82.152Q S82.152R S82.152S S82.154A S82.154B S82.154C
S82.154K S82.154M S82.154N S82.154P S82.154Q S82.154R S82.154S
S82.155A S82.155B S82.155C S82.155K S82.155M S82.155N S82.155P
S82.155Q S82.155R S82.155S S82.161A S82.161K S82.161P S82.161S
S82.162A S82.162K S82.162P S82.162S S82.191A S82.191B S82.191C
S82.191K S82.191M S82.191N S82.191P S82.191Q S82.191R S82.191S
S82.192A S82.192B S82.192C S82.192K S82.192M S82.192N S82.192P
S82.192Q S82.192R S82.192S S82.201A S82.201B S82.201C S82.201K
S82.201M S82.201N S82.201P S82.201Q S82.201R S82.201S S82.202A
S82.202B S82.202C S82.202K S82.202M S82.202N S82.202P S82.202Q
S82.202R S82.202S S82.221A S82.221B S82.221C S82.221K S82.221M
S82.221N S82.221P S82.221Q S82.221R S82.221S S82.222A S82.222B
S82.222C S82.222K S82.222M S82.222N S82.222P S82.222Q S82.222R
S82.222S S82.224A S82.224B S82.224C S82.224K S82.224M S82.224N
S82.224P S82.224Q S82.224R S82.224S S82.225A S82.225B S82.225C
S82.225K S82.225M S82.225N S82.225P S82.225Q S82.225R S82.225S
S82.231A S82.231B S82.231C S82.231K S82.231M S82.231N S82.231P
S82.231Q S82.231R S82.231S S82.232A S82.232B S82.232C S82.232K
S82.232M S82.232N S82.232P S82.232Q S82.232R S82.232S S82.234A
S82.234B S82.234C S82.234K S82.234M S82.234N S82.234P S82.234Q
S82.234R S82.234S S82.235A S82.235B S82.235C S82.235K S82.235M
S82.235N S82.235P S82.235Q S82.235R S82.235S S82.241A S82.241B
S82.241C S82.241K S82.241M S82.241N S82.241P S82.241Q S82.241R
S82.241S S82.242A S82.242B S82.242C S82.242K S82.242M S82.242N
S82.242P S82.242Q S82.242R S82.242S S82.244A S82.244B S82.244C
S82.244K S82.244M S82.244N S82.244P S82.244Q S82.244R S82.244S
S82.245A S82.245B S82.245C S82.245K S82.245M S82.245N S82.245P
S82.245Q S82.245R S82.245S S82.251A S82.251B S82.251C S82.251K
S82.251M S82.251N S82.251P S82.251Q S82.251R S82.251S S82.252A
S82.252B S82.252C S82.252K S82.252M S82.252N S82.252P S82.252Q
S82.252R S82.252S S82.254A S82.254B S82.254C S82.254K S82.254M
S82.254N S82.254P S82.254Q S82.254R S82.254S S82.255A S82.255B
S82.255C S82.255K S82.255M S82.255N S82.255P S82.255Q S82.255R
S82.255S S82.261A S82.261B S82.261C S82.261K S82.261M S82.261N
S82.261P S82.261Q S82.261R S82.261S S82.262A S82.262B S82.262C
S82.262K S82.262M S82.262N S82.262P S82.262Q S82.262R S82.262S
S82.264A S82.264B S82.264C S82.264K S82.264M S82.264N S82.264P
S82.264Q S82.264R S82.264S S82.265A S82.265B S82.265C S82.265K
S82.265M S82.265N S82.265P S82.265Q S82.265R S82.265S S82.291A
S82.291B S82.291C S82.291K S82.291M S82.291N S82.291P S82.291Q
S82.291R S82.291S S82.292A S82.292B S82.292C S82.292K S82.292M
S82.292N S82.292P S82.292Q S82.292R S82.292S S82.301K S82.301M
S82.301N S82.301P S82.301Q S82.301R S82.301S S82.302K S82.302M
S82.302N S82.302P S82.302Q S82.302R S82.302S S82.311A S82.311K
S82.311P S82.311S S82.312A S82.312K S82.312P S82.312S S82.391K
S82.391M S82.391N S82.391P S82.391Q S82.391R S82.391S S82.392K
S82.392M S82.392N S82.392P S82.392Q S82.392R S82.392S S82.401A
S82.401B S82.401C S82.401K S82.401M S82.401N S82.401P S82.401Q
S82.401R S82.401S S82.402A S82.402B S82.402C S82.402K S82.402M
S82.402N S82.402P S82.402Q S82.402R S82.402S S82.421A S82.421B
S82.421C S82.421K S82.421M S82.421N S82.421P S82.421Q S82.421R
S82.421S S82.422A S82.422B S82.422C S82.422K S82.422M S82.422N
S82.422P S82.422Q S82.422R S82.422S S82.424A S82.424B S82.424C
S82.424K S82.424M S82.424N S82.424P S82.424Q S82.424R S82.424S
S82.425A S82.425B S82.425C S82.425K S82.425M S82.425N S82.425P
S82.425Q S82.425R S82.425S S82.431A S82.431B S82.431C S82.431K
S82.431M S82.431N S82.431P S82.431Q S82.431R S82.431S S82.432A
S82.432B S82.432C S82.432K S82.432M S82.432N S82.432P S82.432Q
S82.432R S82.432S S82.434A S82.434B S82.434C S82.434K S82.434M
S82.434N S82.434P S82.434Q S82.434R S82.434S S82.435A S82.435B
S82.435C S82.435K S82.435M S82.435N S82.435P S82.435Q S82.435R
S82.435S S82.441A S82.441B S82.441C S82.441K S82.441M S82.441N
S82.441P S82.441Q S82.441R S82.441S S82.442A S82.442B S82.442C
S82.442K S82.442M S82.442N S82.442P S82.442Q S82.442R S82.442S
S82.444A S82.444B S82.444C S82.444K S82.444M S82.444N S82.444P
S82.444Q S82.444R S82.444S S82.445A S82.445B S82.445C S82.445K
S82.445M S82.445N S82.445P S82.445Q S82.445R S82.445S S82.451A
S82.451B S82.451C S82.451K S82.451M S82.451N S82.451P S82.451Q
S82.451R S82.451S S82.452A S82.452B S82.452C S82.452K S82.452M
S82.452N S82.452P S82.452Q S82.452R S82.452S S82.454A S82.454B
S82.454C S82.454K S82.454M S82.454N S82.454P S82.454Q S82.454R
S82.454S S82.455A S82.455B S82.455C S82.455K S82.455M S82.455N
S82.455P S82.455Q S82.455R S82.455S S82.461A S82.461B S82.461C
S82.461K S82.461M S82.461N S82.461P S82.461Q S82.461R S82.461S
S82.462A S82.462B S82.462C S82.462K S82.462M S82.462N S82.462P
S82.462Q S82.462R S82.462S S82.464A S82.464B S82.464C S82.464K
S82.464M S82.464N S82.464P S82.464Q S82.464R S82.464S S82.465A
S82.465B S82.465C S82.465K S82.465M S82.465N S82.465P S82.465Q
S82.465R S82.465S S82.491A S82.491B S82.491C S82.491K S82.491M
S82.491N S82.491P S82.491Q S82.491R S82.491S S82.492A S82.492B
S82.492C S82.492K S82.492M S82.492N S82.492P S82.492Q S82.492R
S82.492S S82.51XK S82.51XM S82.51XN S82.51XP S82.51XQ S82.51XR
S82.51XS S82.52XK S82.52XM S82.52XN S82.52XP S82.52XQ S82.52XR
S82.52XS S82.54XK S82.54XM S82.54XN S82.54XP S82.54XQ S82.54XR
S82.54XS S82.55XK S82.55XM S82.55XN S82.55XP S82.55XQ S82.55XR
S82.55XS S82.61XK S82.61XM S82.61XN S82.61XP S82.61XQ S82.61XR
S82.61XS S82.62XK S82.62XM S82.62XN S82.62XP S82.62XQ S82.62XR
S82.62XS S82.64XK S82.64XM S82.64XN S82.64XP S82.64XQ S82.64XR
S82.64XS S82.65XK S82.65XM S82.65XN S82.65XP S82.65XQ S82.65XR
S82.65XS S82.811A S82.811K S82.811P S82.811S S82.812A S82.812K
S82.812P S82.812S S82.821A S82.821K S82.821P S82.821S S82.822A
S82.822K S82.822P S82.822S S82.831A S82.831B S82.831C S82.831K
S82.831M S82.831N S82.831P S82.831Q S82.831R S82.831S S82.832A
S82.832B S82.832C S82.832K S82.832M S82.832N S82.832P S82.832Q
S82.832R S82.832S S82.841K S82.841M S82.841N S82.841P S82.841Q
S82.841R S82.841S S82.842K S82.842M S82.842N S82.842P S82.842Q
S82.842R S82.842S S82.844K S82.844M S82.844N S82.844P S82.844Q
S82.844R S82.844S S82.845K S82.845M S82.845N S82.845P S82.845Q
S82.845R S82.845S S82.851K S82.851M S82.851N S82.851P S82.851Q
S82.851R S82.851S S82.852K S82.852M S82.852N S82.852P S82.852Q
S82.852R S82.852S S82.854K S82.854M S82.854N S82.854P S82.854Q
S82.854R S82.854S S82.855K S82.855M S82.855N S82.855P S82.855Q
S82.855R S82.855S S82.861A S82.861B S82.861C S82.861K S82.861M
S82.861N S82.861P S82.861Q S82.861R S82.861S S82.862A S82.862B
S82.862C S82.862K S82.862M S82.862N S82.862P S82.862Q S82.862R
S82.862S S82.864A S82.864B S82.864C S82.864K S82.864M S82.864N
S82.864P S82.864Q S82.864R S82.864S S82.865A S82.865B S82.865C
S82.865K S82.865M S82.865N S82.865P S82.865Q S82.865R S82.865S
S82.871K S82.871M S82.871N S82.871P S82.871Q S82.871R S82.871S
S82.872K S82.872M S82.872N S82.872P S82.872Q S82.872R S82.872S
S82.874K S82.874M S82.874N S82.874P S82.874Q S82.874R S82.874S
S82.875K S82.875M S82.875N S82.875P S82.875Q S82.875R S82.875S
S82.891K S82.891M S82.891N S82.891P S82.891Q S82.891R S82.891S
S82.892K S82.892M S82.892N S82.892P S82.892Q S82.892R S82.892S
S82.91XK S82.91XM S82.91XN S82.91XS S82.92XK S82.92XM S82.92XN
S82.92XS S83.001A S83.002A S83.004A S83.005A S83.011A S83.012A
S83.014A S83.015A S83.091A S83.092A S83.094A S83.095A S83.101A
S83.102A S83.104A S83.105A S83.111A S83.112A S83.114A S83.115A
S83.121A S83.122A S83.124A S83.125A S83.131A S83.132A S83.134A
S83.135A S83.141A S83.142A S83.144A S83.145A S83.191A S83.192A
S83.194A S83.195A S83.200A S83.201A S83.203A S83.204A S83.206A
S83.207A S83.211A S83.212A S83.221A S83.222A S83.231A S83.232A
S83.241A S83.242A S83.251A S83.252A S83.261A S83.262A S83.271A
S83.272A S83.281A S83.282A S83.31XA S83.32XA S83.401A S83.402A
S83.411A S83.412A S83.421A S83.422A S83.501A S83.502A S83.511A
S83.512A S83.521A S83.522A S83.8X1A S83.8X2A S86.111A S86.112A
S86.211A S86.212A S86.311A S86.312A S86.811A S86.812A S89.001A
S89.001K S89.001P S89.001S S89.002A S89.002K S89.002P S89.002S
S89.011A S89.011K S89.011P S89.011S S89.012A S89.012K S89.012P
S89.012S S89.021A S89.021K S89.021P S89.021S S89.022A S89.022K
S89.022P S89.022S S89.031A S89.031K S89.031P S89.031S S89.032A
S89.032K S89.032P S89.032S S89.041A S89.041K S89.041P S89.041S
S89.042A S89.042K S89.042P S89.042S S89.091A S89.091K S89.091P
S89.091S S89.092A S89.092K S89.092P S89.092S S89.101K S89.101P
S89.101S S89.102K S89.102P S89.102S S89.111K S89.111P S89.111S
S89.112K S89.112P S89.112S S89.121K S89.121P S89.121S S89.122K
S89.122P S89.122S S89.131K S89.131P S89.131S S89.132K S89.132P
S89.132S S89.141K S89.141P S89.141S S89.142K S89.142P S89.142S
S89.191K S89.191P S89.191S S89.192K S89.192P S89.192S S89.201A
S89.201K S89.201P S89.201S S89.202A S89.202K S89.202P S89.202S
S89.211A S89.211K S89.211P S89.211S S89.212A S89.212K S89.212P
S89.212S S89.221A S89.221K S89.221P S89.221S S89.222A S89.222K
S89.222P S89.222S S89.291A S89.291K S89.291P S89.291S S89.292A
S89.292K S89.292P S89.292S S89.301K S89.301P S89.301S S89.302K
S89.302P S89.302S S89.311K S89.311P S89.311S S89.312K S89.312P
S89.312S S89.321K S89.321P S89.321S S89.322K S89.322P S89.322S
S89.391K S89.391P S89.391S S89.392K S89.392P S89.392S T84.012A
T84.013A T84.022A T84.023A T84.032A T84.033A T84.042A T84.043A
T84.052A T84.053A T84.062A T84.063A T84.092A T84.093A T84.114A
T84.115A T84.116A T84.117A T84.124A T84.125A T84.126A T84.127A
T84.194A T84.195A T84.196A T84.197A T84.410A T84.420A T84.498A
T84.53XA T84.54XA T84.81XA T84.82XA T84.83XA T84.84XA T84.85XA
T84.86XA T84.89XA Z96.651 Z96.652 Z96.653

Covered Diagnosis Codes for Procedure Codes L1850, L1860

G80.0 G80.1 G80.2 G80.3 G80.4 G80.8 G80.9
M21.861 M21.862 M21.859